采用三维 CT 血管造影术检测腹主动脉瘤修复术后 AneuRx 支架移植物中的缝线断裂和金属环骨折：与晚期内漏发展和器械迁移的关系。
Detection of broken sutures and metal-ring fractures in AneuRx stent-grafts by using three-dimensional CT angiography after endovascular abdominal aortic aneurysm repair: association with late endoleak development and device migration.
机构信息
From the Department of Radiology, Stanford University School of Medicine, Stanford, Calif, and Department of Radiology, St Luke's International Hospital, 9-1 Akashi cho, Chuo-ku, Tokyo 104-8560, Japan (T.U.); Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan (H.T.); Northern Virginia Radiology Consultants, Arlington, Va (I.P.); and Department of Radiology, Duke University Medical Center, Durham, NC (G.D.R.).
出版信息
Radiology. 2014 Jul;272(1):275-83. doi: 10.1148/radiol.14130920. Epub 2014 Mar 21.
PURPOSE
To determine the prevalence of demonstrable stent-graft degradation by using three-dimensional computed tomographic (CT) angiography to assess endoleak and stent-graft migration after endovascular aortic aneurysm repair (EVAR).
MATERIALS AND METHODS
The institutional review board approved this retrospective study. Sixty-two consecutive patients with abdominal aortic aneurysm treated with the AneuRx stent-graft (Medtronic, Santa Rosa, Calif) were assessed between 0.5 and 9.5 years after EVAR (median, 5.1 years) for the presence of broken attachment sutures and metal-ring fractures by using CT angiography. The relative risk (RR) of delayed endoleak formation and endograft migration was calculated relative to the presence of suture breaks and metal-ring fractures. A two-tailed Fisher exact test was used to assess significant differences.
RESULTS
Suture breaks were observed in 55 of 62 subjects (89%), including 37 minor breaks (60%) and 18 major breaks (29%). Metal-ring fractures were observed in 11 of 62 subjects (18%). Twenty-seven endoleaks were observed in 24 of 62 subjects (39%) and were categorized as type I in seven of 27 (11%), type II in 16 of 27 (26%), and type III in four of 27 (6%). Major suture breaks were associated with six of seven (86%) delayed type I endoleaks (RR = 19.4, P = .003), and metal-ring fractures were associated with four of seven (57%) delayed type I endoleaks (RR = 6.2, P = .015) and three of four (75%) type III endoleaks (RR = 13.9, P = 003). Migration was observed in 15 of 62 patients (24%) and was associated with major suture breaks in 10 of 15 patients (67%, RR = 4.5, P = .001) and with metal-ring fractures in five of 11 patients (45%, RR = 4.1, P = .003). Repeat interventions were performed in 15 patients.
CONCLUSION
Major suture breaks and metal-ring fractures are demonstrated with CT and are associated with delayed type I and III endoleaks and with stent-graft migration after EVAR.
目的
通过三维计算机断层血管造影术（CTA）评估血管内主动脉瘤修复（EVAR）后的内漏和支架移植物迁移，以确定支架移植物降解的发生率。
材料与方法
本回顾性研究获得机构审查委员会批准。62 例接受 AneuRx 支架（美敦力，加利福尼亚州圣罗莎）治疗的腹主动脉瘤患者，在 EVAR 后 0.5 至 9.5 年（中位时间 5.1 年）时，通过 CTA 评估断钉缝线和金属环骨折的存在情况。相对于缝线断裂和金属环骨折的存在，计算延迟内漏形成和移植物迁移的相对风险（RR）。采用双尾 Fisher 精确检验评估显著差异。
结果
55 例（89%）患者的缝线断裂，包括 37 例（60%）小断裂和 18 例（29%）大断裂。11 例（18%）患者的金属环骨折。27 例（39%）患者中有 27 例内漏，7 例（11%）为 I 型，16 例（26%）为 II 型，4 例（6%）为 III 型。大的缝线断裂与 7 例（86%）延迟 I 型内漏有关（RR=19.4，P=0.003），金属环骨折与 7 例（57%）延迟 I 型内漏有关（RR=6.2，P=0.015）和 4 例（75%）III 型内漏有关（RR=13.9，P=0.003）。15 例（24%）患者发生移植物迁移，10 例（67%）大缝线断裂患者（RR=4.5，P=0.001）和 5 例（45%）金属环骨折患者（RR=4.1，P=0.003）发生移植物迁移。15 例患者接受了重复干预。
结论
CT 显示大的缝线断裂和金属环骨折与 EVAR 后延迟的 I 型和 III 型内漏以及支架移植物迁移有关。
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